High complication rate in Crohn's disease surgery following percutaneous drainage of intra-abdominal abscess: a multicentre study
Related Experiment Video
Updated: Sep 22, 2025
Author Spotlight: Advancements in Retroperitoneal Approach for Necrotizing Pancreatitis
Published on: March 15, 2024
Valerio Celentano1,2,3, Mariano Cesare Giglio4, Gianluca Pellino5
1Chelsea and Westminster Hospital NHS Foundation Trust, London, UK. valeriocelentano@yahoo.it.
Insights
Patients with Crohn's disease (CD) needing abscess drainage before surgery face higher risks of complications. Radiological drainage of intra-abdominal abscesses in CD patients increases postoperative morbidity and anastomotic leaks.
Area of Science:
- Gastroenterology
- Colorectal Surgery
- Surgical Oncology
Background:
- Intra-abdominal abscesses in Crohn's disease (CD) complicate treatment, potentially delaying immunosuppression and increasing surgical risks.
- Treatment options for abscesses include conservative management, percutaneous drainage, and surgery, each with distinct outcomes.
- Preoperative radiological drainage is a strategy to manage abscesses before ileocolonic resection in CD.
Purpose of the Study:
- To audit the short-term outcomes of patients undergoing preoperative radiological drainage of intra-abdominal abscesses before ileocolonic resection for Crohn's disease.
- To compare postoperative morbidity and complications between CD patients who had preoperative drainage and those who did not.
Main Methods:
- Retrospective, multicentre, observational study of adult patients undergoing ileocolic resection for CD.
- Inclusion criteria: primary or recurrent CD, June 2018 - May 2019.
- Outcomes assessed: 30-day postoperative morbidity, length of stay, and anastomotic leak rate.
Main Results:
- 36 out of 575 patients (6.2%) underwent preoperative abscess drainage.
- Patients with preoperative drainage showed significantly higher postoperative morbidity (44.4%) and anastomotic leak rates (11.1%).
Conclusions:
- Preoperative radiological drainage of intra-abdominal abscesses in Crohn's disease patients is associated with increased postoperative morbidity.
- These patients face a higher risk of septic complications after ileocaecal or re-do ileocolic resection.
Introduction:
Intra-abdominal abscesses complicating Crohn's disease (CD) present an additional challenge as their presence can contraindicate immunosuppressive treatment whilst emergency surgery is associated with high stoma rate and complications. Treatment options include a conservative approach, percutaneous drainage, and surgical intervention. The current multicentre study audited the short-term outcomes of patients who underwent preoperative radiological drainage of intra-abdominal abscesses up to 6 weeks prior to surgery for ileocolonic CD.
Methods:
This is a retrospective, multicentre, observational study promoted by the Italian Society of Colorectal Surgery (SICCR), including all adults undergoing ileocolic resection for primary or recurrent CD from June 2018 to May 2019. The outcomes of patients who underwent radiological guided drainage prior to ileocolonic resection were compared to the patients who did not require preoperative drainage. Postoperative morbidity within 30 days of surgery was the primary endpoint. Postoperative length of hospital stay (LOS) and anastomotic leak rate were the secondary outcomes.
Results:
Amongst a group of 575 included patients who had an ileocolic resection for CD, there were 36 patients (6.2%) who underwent abscess drainage prior to surgery. Postoperative morbidity (44.4%) and anastomotic leak (11.1%) were significantly higher in the group of patients who underwent preoperative drainage.
Conclusions:
Patients with Crohn's disease who require preoperative radiological guided drainage of intra-abdominal abscesses are at increased risk of postoperative morbidity and septic complications following ileocaecal or re-do ileocolic resection.
Related Concept Videos
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
01:17Chronic Bowel Disorders: Introduction
Irritable Bowel Syndrome (IBS) is a common disorder affecting the gastrointestinal tract. The distinctive feature is recurrent abdominal pain associated with altered bowel movements, manifesting as constipation, diarrhea, or fluctuating between both. The...
01:27Inflammatory Bowel Disease I: Ulcerative Colitis
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
01:30Inflammatory Bowel Disease II: Crohn's Disease
Inflammatory bowel disease, commonly known as IBD, refers to a collection of disorders that lead to persistent inflammation of the gastrointestinal tract. The two types of IBD are ulcerative colitis, which impacts the colon, and Crohn's disease, which can involve any part of the gastrointestinal segment.
Crohn's disease
Crohn's disease is a chronic, systemic inflammatory bowel disease (IBD) that predominantly affects the gastrointestinal tract. It is marked by...
01:25Peritoneal Dialysis II: Peritoneal Dialysis Systems and Complications
01:29Appendicitis-II: Diagnostic Studies and Management
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...